301-994-3023

How to Talk to Your Patients about Hospice

Setting the Stage

  • Choose a private environment that is conducive to open discussion. Try to provide seating for everyone that will be present for the discussion. This will allow the patient to feel as though they are not being rushed. Have tissues available.
  • With the patient's permission, invite the patient's family/friends/decision makers to be part of the discussion.
  • Allot plenty of time in your schedule, at least 20 to 30 minutes, in order to thoroughly discuss the patient's prognosis and whatever options may be available to the patient.
  • Turn beepers and cell phones to vibrate; do not allow any interruption and give the patient your undivided attention.
  • Introduce yourself to everyone in the room and sit in a position on the patient's level, where you can maintain eye contact.

Having the Conversation

Identify who the decision makers are; it may not always be the patient.

► Ask questions like:

"Who do you rely on to help you make important decisions?"

Assess the patient's understanding of his or her prognosis and fill in any gaps.

► Ask questions like: 

"What do you understand about your condition?"

"Do you think you will get better, worse or stay the same over the next few months?"

► Provide general estimates for how long the patient will survive and details on how the condition will progress.

Identify the patient's/family's goals for care.

► Ask questions like: 

"What do you hope for most over the next few months?" 

"Is there anything you are afraid of?" 

"Is there anything you need or want?"

► Admit limitations: 

"I wish we could guarantee....but unfortunately we can't." 

"Perhaps we can....instead."

Identify needs for care.

► Ask questions like:

"It can be difficult to care for a family member at home; no one can do it alone. Have you thought about what kind of help you might need?"

"Would it help if we could send a nurse to your home to check on you?"

"Are there any financial, emotional and/or spiritual issues you would like help with?"

Summarize the patient's/family's goals.

► Make statements like:

"It sounds like your main goal is to stay at home and be with your family and remain in control of your care."

"I can tell you want to be as independent as possible and not be a burden to your family. Having a nurse visit at home and having some help around the house might make that possible."

Introduce Hospice as a way to achieve the patient's/family's goals. 

► Make statements like:

"One of the best ways to give you the help you will need to stay at home with your family is Hospice. Hospice can also provide care in nursing homes and assisted-living residences. Have you heard of Hospice?"

"Hospice is able to provide more services and support at home than most other home-care programs. The Hospice team has a lot of experience caring for terminally ill patients at home."

"Hospice helps people die comfortably in their own time and helps people live as well as they can for as long as they can."

Respond, reaffirm and recommend hospice.

► Make statements like:

"I can see it's not easy for you to talk about this. Tell me what's upsetting you the most."

"I usually recommend that Hospice get involved for patients at this stage of their illness."

"I will continue to be your physician while you are with Hospice and will work with the Hospice team to ensure you remain pain-free and comfortable."

"I think Hospice would be your best choice right now, but, of course, the final decision is yours. Think this over for a couple of days."

"You know I will continue to care for you whatever decision you make."

"If you want, I can arrange for a Hospice nurse or social worker to visit you so that you can decide for yourself whether Hospice is right for you."